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COMMUNITY PROFILE AND BACKGROUND 1. Provide the following community information. Local overnmental unit Contact name Contact title Address Cit , State, and Zi Tele hone number FAX number Email address Date of re aration 2. Identify type of amendment. Check all that apply: X 2a. Land use change. Complete questions 1-28 and describe: Change the subject ro ert 's land use desi nation from Rural Develo in to Low Densit Residential X 2b. MUSA Expansion. Complete questions 1-34 and describe: Expand the MUSA to include the sub'ect ro ert 2c. Text Chan e. Com lete uestions 1-6 and 7-28, as a Iicable, and describe: 2d. Other. Describe: 3. Provide a description of the amendment. Name of amendment Mari old Pond General location Hi hwa 47 at 160 Lane NW Brief description Expand the MUSA to include the subject property, changing the land use from Rural Develo in to Low Densit Residential Affected area, in acres 58 4. Indicate official local status of the plan amendment. (Check all that apply.) The local governing body must take action on the proposed amendment before submittal to the Metropolitan Council. Include staff report to the planning commission or governing body when submitting this form. Action X Acted u on b lannin commission X Approved by governing body, contingent upon Metro olitan Council review Date of Action, June 2, 2005 June 28, 2005 5. Indicate if the City determined whether the proposed amendment would impact adjacent communities and other jurisdictions and identify which ones have been notified (M.S. 473.858, Subd. 2.). Select one of the follow options: List adjacent local governments, school districts, watershed organizations and other .urisdictions and the date the co ies were sent. X Plan amendment will not impact adjacent local governments, school districts, watershed organizations and other jurisdictions, based on community's judgement and completion of this form. January 2005 3